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General NPI Number Information
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NPI Number | 1053825331
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Entity Type | Individual
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Provider Name | CRYSTAL JEANNE SAGE MA, LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/26/2017
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Last Update Date | 01/18/2026
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Provider Practice Location Address
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Address Line | 1980 N ATLANTIC AVE STE 813
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City | COCOA BEACH
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State | FL
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Zip | 32931-3276
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Country | US
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Telephone | 863-866-7065
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Fax | 352-309-0769
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Provider Business Mailing Address
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Address Line | 125 FLORIDA BLVD
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3010
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Country | US
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Telephone | 863-866-7065
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Fax | 352-309-0769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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